Doximity physicians' salary

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How realistic are these. Are PMR and Nephrologists really making >330k?
 
Splenda88 said:
It's a yes for nephrology where I am (major city in southeast)... but I heard it's not easy to find a job.

I don't know about PM&R. @sloh
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I'll quote WCI directly on this:

"I have always been amazed to see intraspecialty income differences that are larger than the classic interspecialty income differences. While there is an impressive difference between the average pediatrician who makes $232K and the average orthopedist who makes $511K, I know both pediatricians and orthopedists who make twice those averages."

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My last month's gross paycheck (what went into my bank account) was approximately 60-65k just to give you some actual numbers. Intra-specialty income differences can be just as, if not greater, than inter-specialty income differences, especially when you look outside of W2 positions.

A PM&R W2 position at Kaiser currently caps out at around 290k in SoCal. They offer good benefits and pension plan though. As a 1099 and no benefits, to break even, you'd want to be making 350k/yr.
 
sloh said:
My last month's gross paycheck (what went into my bank account) was approximately 60-65k just to give you some actual numbers. Intra-specialty income differences can be just as, if not greater, than inter-specialty income differences, especially when you look outside of W2 positions.

A PM&R W2 position at Kaiser currently caps out at around 290k in SoCal. They offer good benefits and pension plan though. As a 1099 and no benefits, to break even, you'd want to be making 350k/yr.
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You should be semi retired by now... You've been making insane $$$ for over 3 yrs now. Lol
 
Splenda88 said:
You should be semi retired by now... You've been making insane $$$ for over 3 yrs now. Lol
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I only finished residency 06/2019 actually! And then I kind of wasted a year as a W2 at a job that wasn't suitable for me. 2-3 million (ideally 4) in investable assets for financial independence asap is the goal!
 
based on your yearly salary, this is extremely doable and in a fairly short amount of years. I am presuming ortho spine or neurosurgery?
 
Dr. Anonymouss said:
How in the hell does a PM&R doc make roughly 720-780k a year...
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It’d be a rough work-life balance. But in inpatient PM&R you can easily make $300-500k with a decent lifestyle.

I think the average private practice physiatrist makes in the 300’s. Academic tend to make closer to 200’s. A county hospital offered me $260k for general patient rehab, just to give a rough idea.

Still, I really don’t know how representative any of the data is here. I’m assuming it’s just like those Medscape surveys—self-reported income on surveys with a low response/return rate.

edit: corrected a typo.
 
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Sloh how did you do leverage your training? How did you find your positions? Any luck involved?
 
sloh said:
I only finished residency 06/2019 actually! And then I kind of wasted a year as a W2 at a job that wasn't suitable for me. 2-3 million (ideally 4) in investable assets for financial independence asap is the goal!
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What kind of doc are you? Whats your net per month?
 
TikiTorches said:
What kind of doc are you? Whats your net per month?
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I'm PM&R. I originally wanted to do a pain and or sports med fellowship after residency but was very disillusioned with the lack of effectiveness for most of the procedures (after getting well acquainted with the evidence/literature during residency)—so I never pursued a fellowship. Yes, I pretty much make more than pain docs and I work less than 40 hours/week.

The numbers I posted above (60-65k gross income last month) are after overhead. I am an independent contractor and the companies I work for take 30% of my collections, and the rest goes into my bank account. That 30% covers the overhead, (billing, compliance, EMR, etc). The work I do, subacute rehab consulting, is very low overhead. I don't need nurses to room patients (the patients are already in their rooms or I see them when them in the PT gym while they are doing therapies), I don't need clinic rooms, I don't need a work office (I document remotely at home on my laptop after I round on patients in the morning).
Cath Up said:
Sloh how did you do leverage your training? How did you find your positions? Any luck involved?
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I actually found residency training not very reflective of real world practice, and I went to a very well regarded academic residency. PM&R residency focuses on a lot of superfluous details (e.g. special orthopaedic tests that have such poor reliability and validity that they are pretty much useless) and "glamorous" things like ultrasound guided injections which not only reimburse poorly...at best they are just placebos and at worse they harm patients in the long term (e.g. the deleterious effects of corticosteroids is well-documented).

I started looking into subacute rehab consulting jobs while I was in residency when I talked to potential employers at our annual specialty conferences. I also saw these job postings on sites like doccafe, so I read more about it on SDN. There was no exposure to SAR at my residency.

If you want to make a lot of money in PM&R ***and are very efficient***, I think inpatient (acute inpatient, subacute rehab) is where it's at. Residency does not teach you this. This starts to become very obvious if you start working as a 1099 and start to get familiar with coding and billing (which they also don't teach you in residency). I have a good friend who does acute inpatient rehab (not subacute rehab) and his gross income is around 45k/month last I talked to him. The logistics of inpatient beat out clinic from a patient volume standpoint. In clinic, you have to waste time rooming patients, schedule patients into time slots, and there's also a certain expectation from patients presenting for a clinic visit that you will spend a certain amount of time with them (usually much more than rounding on patients in an inpatient setting). In the inpatient setting, and especially for PM&R, the patients are pretty stable, you can round on patients one right after another very efficiently.

I learned a lot about coding and billing on the SDN forums. While I was ramping up, using the search function and just perusing the psychiatry, derm, ophthalmology, forums wrt coding/billing helped a lot. My income is definitely not the norm and my point was simply the variance within each specialty can be very very high (especially if you have the initiative to learn about the business of medicine, coding, billing, etc. after residency). You see this all the time in ophtho and even psychiatry. Even psychiatrists who do inpatient, and especially if they have NP's/PA's working under them, can make close to 1 million per year. A lot of physicians don't want to do this, which is understandable, and for them a W2 where you can just clock in and clock out is more fitting. I worked as a W2 and from my experience, employers will squeeze you for all your worth (e.g. lots of uncompensated work answering patient inbox messages and returning patient phone calls) and you are not really compensated commensurately for your work.
 
Interesting that EM compensation increased given the job market.
 
Sorry if this is a dumb question What is considered subacute rehab? Like what types of patients are you seeing and what types of things are you doing ?
 
Hospitalist here. If you’re willing to work in a rural area and dont mind working a lot of extra shifts, you can easily hit 360k a year or more. I’d say the survey results are fairly accurate for averages. I worked part time the last several years and was able to hit $280-$310k pretty easily.
More important than salary though is longevity and job satisfaction. This is where most physician jobs are failing miserably IMO, especially hospitalist work.
 
georgia_boy1 said:
Sorry if this is a dumb question What is considered subacute rehab? Like what types of patients are you seeing and what types of things are you doing ?
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Not a dumb question at all for people who aren't familiar with PM&R. Subacute rehab is usually for patients who cannot tolerate acute inpatient rehab (at least 3 hours per day x 5 days per week). The patients in subacute rehab get less intensive and shorter therapy sessions per day and a longer overall stay in the SNF's. Another difference is that PM&R is usually primary for acute inpatient rehab, so they are responsible for managing all the acute/urgent medical issues that come up. In the subacute setting, PM&R is usually just a consultant, so they get to focus just on rehab and musculoskeletal related issues. This also makes the acute inpatient rehab job more demanding and will usually involve taking call (usually home call) and rounding on weekends.

In an ideal world, I think the best set-up would be PM&R as consultant in acute inpatient rehab so they can focus on rehab and musculoskeletal related issues. As a resident, I always felt like I was internist-lite on my acute inpatient rehab rotations. I generally find patients in the acute inpatient rehab setting more motivated and tbh more of a joy to work with.

Wrt SAR vs. acute IPR, the trend seems to be a general shunting of more patients getting rehab in SNF settings. Reference the article below for more info:

"Rehabilitation in the skilled nursing facility environment is rapidly emerging as the predominant level of inpatient rehabilitation care in the United States. The effects of the so-called 60% rule, level of care determinations by payers, and other restrictions on IRF rehabilitation, have led to a 25% decline in IRF cases between 2004 and 2013. More patients receive will their inpatient rehabilitation in a SNF today than in an IRF – and the trend is likely to continue."

www.mcknights.com

The physiatrist's role in post-acute rehabilitation - McKnight's Long Term Care News

In the IRF environment, it is mandated by federal regulation that the rehabilitation physician performs several key functions. It is not specified that this doctor necessarily be a physiatrist, but only a physician with training and experience in rehabilitation. In the SNF environment, there is...
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It doesn’t seem realistic for non-invasive cardiologists to be making $500k a year... I’m assuming the numbers are super overinflated since they don’t differentiate the salaries of the cath folks from everyone else.
 
Keep2r said:
It doesn’t seem realistic for non-invasive cardiologists to be making $500k a year... I’m assuming the numbers are super overinflated since they don’t differentiate the salaries of the cath folks from everyone else.
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Not sure how many cardiologists you know but 500k is very realistic for non-invasive guys based on the ones in my school's cardiology department. One of the interventionalists told me that some of the non-invasive ones in their group actually make more than they (the cath guys) do.
 
Why does rad-onc have the biggest doom and gloom vibes on SDN (second to path maybe) when they're still pulling 500+? It can't be THAT oversaturated with salaries that high
 
Student189045 said:
Why does rad-onc have the biggest doom and gloom vibes on SDN (second to path maybe) when they're still pulling 500+? It can't be THAT oversaturated with salaries that high
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See above.

See for yourself if you want at our specialty's career search site. Lots of Midwest/rural jobs. For now.

On top of that, major explosion the last decade in trash unaccredited fellowships, basically exploiting the oversupply of residents coming out who have to live in certain cities and metros. That, in and of itself, is damning enough.

Remember, not a single fellowship in Rad Onc is accredited by the ACGME. None of us who graduated a decade ago during peak rad onc needed fellowships to find jobs. Nowadays, people are trying to use them to get their foot in the door

Great example of a well known PP offering an unaccredited fellowship...a decade ago, this would have been an entry level partnership track position probably: Proton Therapy Fellow in Fairfax, VA for Inova Health System
 
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Student189045 said:
Why does rad-onc have the biggest doom and gloom vibes on SDN (second to path maybe) when they're still pulling 500+? It can't be THAT oversaturated with salaries that high
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1) Without digging into the methods - I presume this report compiles data from all currently practicing physicians (as in, it's not limited to just those <5 years out of residency)? RadOnc is not a physically taxing specialty. I personally know docs who have practiced for 30-40 years. Those folks who have been at it since the late 80s, especially the partners in private practice, really skew the data towards the high end.

2) While I definitely know new grads who have signed gigs for ~$500k/year right out of the gate, most people in desirable coastal/metro areas are signing for $290k-$360k (per our own specialty polling, I think median was 300k or 350k last year pre-COVID). Depending on which hospital/what level you're hired at, Harvard pays as low as $180k. Stanford is in that ballpark as well. You pay for prestige and location.

3) Per that same internal specialty (ASTRO) presentation from this year, we have the worst wage stagnation in all of medicine (#19 of 19 specialties). Salaries massively increased in the late 2000s/early 2010s, the government caught on and have been coming after us ever since (even though, on a societal level, we are far more cost effective than something like Keytruda).

I'm a graduating PGY-5 at a well-known program - I frame the market as such:

1) I matched at the height of RadOnc competitiveness in 2016, when everyone had a 260+ Step 1, junior AOA, and 15 publications. Matching into RadOnc in 2016 was easy compared to the job market I faced.

2) I'm a first generation college student from a no-name undergrad. I didn't even know how college credits worked my first semester. I was accepted to multiple MD-PhD programs throughout the country with that background. That was easy compared to the job market I faced.

Looking at current RadOnc average salaries and drawing any conclusions about the job market for current/future new grads is the epitome of "buy high, sell low".
 
elementaryschooleconomics said:
1) Without digging into the methods - I presume this report compiles data from all currently practicing physicians (as in, it's not limited to just those <5 years out of residency)? RadOnc is not a physically taxing specialty. I personally know docs who have practiced for 30-40 years. Those folks who have been at it since the late 80s, especially the partners in private practice, really skew the data towards the high end.

2) While I definitely know new grads who have signed gigs for ~$500k/year right out of the gate, most people in desirable coastal/metro areas are signing for $290k-$360k (per our own specialty polling, I think median was 300k or 350k last year pre-COVID). Depending on which hospital/what level you're hired at, Harvard pays as low as $180k. Stanford is in that ballpark as well. You pay for prestige and location.

3) Per that same internal specialty (ASTRO) presentation from this year, we have the worst wage stagnation in all of medicine (#19 of 19 specialties). Salaries massively increased in the late 2000s/early 2010s, the government caught on and have been coming after us ever since (even though, on a societal level, we are far more cost effective than something like Keytruda).

I'm a graduating PGY-5 at a well-known program - I frame the market as such:

1) I matched at the height of RadOnc competitiveness in 2016, when everyone had a 260+ Step 1, junior AOA, and 15 publications. Matching into RadOnc in 2016 was easy compared to the job market I faced.

2) I'm a first generation college student from a no-name undergrad. I didn't even know how college credits worked my first semester. I was accepted to multiple MD-PhD programs throughout the country with that background. That was easy compared to the job market I faced.

Looking at current RadOnc average salaries and drawing any conclusions about the job market for current/future new grads is the epitome of "buy high, sell low".
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So radonc crashed in <5 years?
 
Lawpy said:
So radonc crashed in <5 years?
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That's what happens when residency slots double while radiation therapy delivery can be delivered in fewer treatments. Finite demand for rad Onc labor. Not the first time either.. rad Onc job market was terrible in the 90s which is when they extended training from 3 to 4 years
 
Lawpy said:
So radonc crashed in <5 years?
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"Crash" is probably an over simplification, but yes, it was rapid.

As @medgator said, residents doubled at an alarming rate. In the early 2000s we had maybe 100 residents a year, and we currently have about 200 residents a year. Best estimates in the literature put people leaving the specialty (retirement or otherwise) at 100/year. There's a lag time of 5 years from starting residency to entering the workforce. I would say growth was most rapid between 2008-2016, and we're currently experiencing the maturation of the expansion.

The government trying to regulate reimbursement - to say nothing of the Alternative Payment Model - would have put downward pressure on the market if we stayed at 100 kids/year. But to double the output at the same time? Madness.

It's not like IM, where you have thousands upon thousands of residents graduating each year, and the addition or subtraction of even a hundred spots is easily absorbed. A change in 25 residents in RadOnc in either direction, on the other hand, has a tangible effect.
 
medgator said:
That's what happens when residency slots double while radiation therapy delivery can be delivered in fewer treatments. Finite demand for rad Onc labor. Not the first time either.. rad Onc job market was terrible in the 90s which is when they extended training from 3 to 4 years
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elementaryschooleconomics said:
"Crash" is probably an over simplification, but yes, it was rapid.

As @medgator said, residents doubled at an alarming rate. In the early 2000s we had maybe 100 residents a year, and we currently have about 200 residents a year. Best estimates in the literature put people leaving the specialty (retirement or otherwise) at 100/year. There's a lag time of 5 years from starting residency to entering the workforce. I would say growth was most rapid between 2008-2016, and we're currently experiencing the maturation of the expansion.

The government trying to regulate reimbursement - to say nothing of the Alternative Payment Model - would have put downward pressure on the market if we stayed at 100 kids/year. But to double the output at the same time? Madness.

It's not like IM, where you have thousands upon thousands of residents graduating each year, and the addition or subtraction of even a hundred spots is easily absorbed. A change in 25 residents in RadOnc in either direction, on the other hand, has a tangible effect.
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If you look at the match data there are other specialties that are ballooning in residency positions as well, such as derm, increasing 81% in the past 10-12ish years. Does that mean derm should be avoided as it faces a similar fate?

The amount of residencies in general is increasing at scary levels. 1990-2010 was an increase of about 2-3k seats whereas from 2010 to now we have seen an increase of 12-14k seats. AND there's a pending bill to add 15k medicare funded seats in the next 5 years. I feel like we're going to blow past the alleged shortage and oversaturate the entire field in a decade.
 
Student189045 said:
If you look at the match data there are other specialties that are ballooning in residencies as well, such as derm, increasing 81% in the past 10-12ish years. Does that mean derm should be avoided as it faces a similar fate?

The amount of residencies in general is increasing at scary levels. 1990-2010 was an increase of about 2-3k seats whereas from 2010 to now we have seen an increase of 12-14k seats. AND there's a pending bill to add 15k medicare funded seats in the next 5 years. I feel like we're going to blow past the alleged shortage and oversaturate the entire field in a decade.
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Much easier to hang your shingle as a PP derm than rad Onc. Open your office, start biopsying and cutting and seeing patients. Derm is starting to saturate in some of the busier areas from what I've heard though. Also seeing a lot of mid-level and private equity encroachment

In rad Onc, A state of the art linear accelerator will set you back at least $2.5m. plus the staff to run it. you can't practice rad Onc without one.
 
Student189045 said:
If you look at the match data there are other specialties that are ballooning in residencies as well, such as derm, increasing 81% in the past 10-12ish years. Does that mean derm should be avoided as it faces a similar fate?

The amount of residencies in general is increasing at scary levels. 1990-2010 was an increase of about 2-3k seats whereas from 2010 to now we have seen an increase of 12-14k seats. AND there's a pending bill to add 15k medicare funded seats in the next 5 years. I feel like we're going to blow past the alleged shortage and oversaturate the entire field in a decade.
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Other specialties have more elasticity than Radiation Oncology for one reason: the linear accelerator. We are tied to a modality, not an organ system. And linear accelerators are often regulated at the state level, where the government must approve a "Certificate of Need" before you can get even a single new linac up and running.

Conversely, a Dermatologist can just rent an office space and be good to go. Yeah, patients might be scare if the market is saturated in that area...but the Dermatologist is not tied to a 3 million dollar machine needing a government stamp and a physics commissioning team.
 
medgator said:
Much easier to hang your shingle as a PP derm than rad Onc. Open your office, start biopsying and cutting and seeing patients. Derm is starting to saturate in some of the busier areas from what I've heard though

In rad Onc, A state of the art linear accelerator will set you back at least $2.5m. plus the staff to run it. you can't practice rad Onc without one.
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@medgator and I are operating on psychic wavelengths this evening.
 
Student189045 said:
If you look at the match data there are other specialties that are ballooning in residency positions as well, such as derm, increasing 81% in the past 10-12ish years. Does that mean derm should be avoided as it faces a similar fate?

The amount of residencies in general is increasing at scary levels. 1990-2010 was an increase of about 2-3k seats whereas from 2010 to now we have seen an increase of 12-14k seats. AND there's a pending bill to add 15k medicare funded seats in the next 5 years. I feel like we're going to blow past the alleged shortage and oversaturate the entire field in a decade.
Click to expand...
Dermatology has matched Rad Onc in the insane expansion rate, however the demand for derm has been increasing as well (although not enough to fully counteract the increase in MDs and Midlevels). In comparison, the demand and treatments for Rad Onc has flat-lined or even decreased (from what I understand) as alternate or different versions of treatments are now favored. So the only thing saving dermatology from suffering the same fate is the increase in demand for dermatology services. Unfortunately this isn't enough to fully compensate and now most desirable cities are saturated and offer few/low paying jobs. However many, rural/suburban/south or midwest areas have a huge need and you can find decent jobs. However, the writing is on the wall in dermatology, and the trend will only continue to worsen. No one can predict how long it will take and how bad it will get. Fortunately right now, dermatology is nowhere near the level of saturation of Rad Onc, but in 10, 20, 30 years things can and will look very different. All that being said, I wouldn't say that's a reason to avoid dermatology if you absolutely love it. Hopefully by the time anyone here would graduate dermatology residency (4-8 years from now) things won't have declined to the point of Rad Onc, but these things are hard to predict.
 
The_RZ_Method said:
Sorry if this is off-topic but I've always wondered what the absolute worst case scenario is in these situations. Say you truly can't find a job in your specialty, how feasible is it to go back and re-train in a different speciality? Is it doable 5-10-15 years out from graduation?

Or would one actually have to leave medicine altogether?
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Not sure about retraining in a diff specialty. Apparently it was more common back in the day but I think it was more of people who switched residencies. But one thought could be to get an MBA and go into hospital administration. Or go work for a pharmaceutical company
 
Dr. Doctor MD said:
No one can predict how long it will take and how bad it will get. Fortunately right now, dermatology is nowhere near the level of saturation of Rad Onc, but in 10, 20, 30 years things can and will look very different. All that being said, I wouldn't say that's a reason to avoid dermatology if you absolutely love it.
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After COVID, I'm now a firm believer that no matter how bad things get, if you love what you do you won't regret it, and I used to think that was absolute bull. I'm an MD/PhD student. Suffice to say, I know what it's like to feel like you're getting stiffed financially. If I didn't love what I do in the lab, I'd be 100% miserable. When COVID hit, I lost my love for the lab. I lost 3 months of work immediately to the shutdowns, scrapping everything I'd done since December. Then I lost another 3 months waiting for the lab to open up again. Then I was forced to work on a completely research-incompatible "shift schedule" to keep lab and office density low. I spent the better part of this year completely miserable. I was absurdly jaded. Only recently have I found a way to make my research work again with these restrictions. As I've come back into the lab and things start to fall back into place, I find myself loving my work and my life again, despite being too poor to afford a car or an apartment without roommates.

If you come into this with high expectations, you will be massively disappointed. Expect salaries in medicine to drop (or at least not keep growth with the rest of the workforce). Expect to be passed over for people who kiss ass better than you. Expect people who work way less hard than you to make way more money. As a physician, you'll make enough to be happy, almost no matter what happens. A year of being jaded and miserable as I watched the world pass me by was enough. I can't even imagine an entire career of it.
 
AnatomyGrey12 said:
Not sure how many cardiologists you know but 500k is very realistic for non-invasive guys based on the ones in my school's cardiology department. One of the interventionalists told me that some of the non-invasive ones in their group actually make more than they (the cath guys) do.
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Really? That’s good to know. What part of the country is this in? If that’s the case idk why interventional is so competitive. The work-life balance seems brutal even as attendings.
 
Keep2r said:
Really? That’s good to know. What part of the country is this in? If that’s the case idk why interventional is so competitive. The work-life balance seems brutal even as attendings.
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Midwest. Interventional has a really high ceiling if you get in the right set up, which is probably why it’s so competitive. There is a PP interventionalist in town that is known to make 2m+. But he is always working and runs his own practice. In between patient visits and cases he bangs out studies and that sort of thing. Does endovascular PVD stenting in his own outpatient cath lab he owns (does hearts in the hospital), etc.
 
Keep2r said:
Really? That’s good to know. What part of the country is this in? If that’s the case idk why interventional is so competitive. The work-life balance seems brutal even as attendings.
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Lol. A PP interventional cardiologist in a town with <150,000 people won’t even get out of bed for 500k.
 
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